Purple urine bag syndrome is a rare, striking medical phenomenon observed in patients having indwelling urinary catheters having urinary tract infection. It is commonly observed in elderly patients having constipation and long-standing indwelling urinary catheters and indicates bacterial urinary tract infection. The purple discoloration of the urinary bag is reported to be due to the presence of indigo and indirubin pigment produced by tryptophan metabolism by Gram-negative Bacteria. The authors present a case of 67-year-old female with purple discoloration of her urine bag due to urinary tract infection caused by Klebsiella pneumoniae.

Renal lymphangiomas are rare benign mass-like renal conditions that refer to the presence of multiple cysts in both the renal sinus and the renal parenchyma. It has been found in both adults and children. The etiology is unknown, but it has been thought to be the result of lymphatic obstruction. Renin-dependent hypertension may be the presenting clinical complaint. The purpose of this study is to describe the radiological appearances of a rare case of renal lymphangioma that we encountered in our hospital.

We report a series of cases with multiple presentations of postpartum acute kidney injury presented to the NIMS Kidney Institute, Jaipur, India.

Objectives: This study aimed to assess the role of varicocelectomy in the improvement of premature ejaculation (PE) in patients with clinical varicoceles and PE. Materials and Methods: In a prospective clinical study, it conducted on 85 male patients with clinical varicoceles and PE. Those patients were selected from whom attending the Outpatient Clinics of Andrology and General Surgery at Sohag University Hospital, Upper Egypt, between February 2015 and May 2016. All patients were subjected to preliminary assessment included a detailed medical and sexual history and general and genital examination. Patients were treated with open bilateral subinguinal varicocelectomy under spinal anesthesia. All patients were evaluated before and 6 months after the varicocelectomy by PE diagnostic tool (PEDT). The intravaginal ejaculatory latency times (IELTs) per minute and overall sexual satisfaction scores were evaluated before and 6 months after varicocelectomy. All patients were asked to indicate their sexual satisfaction on a scale of 0-5, with 0 being extremely dissatisfied and 5 being extremely satisfied. Results: The mean scores of the five questions of the PEDT measuring ejaculation control, frequency of inability of ejaculation control, ejaculation with minimal stimulation, feel of distress, and interpersonal difficulty owing to PE had statistically significant improvements at 6 months after varicocelectomy. The mean IELTs per minute and overall sexual satisfaction scores were significantly improved at 6 months after varicocelectomy. Conclusions: The study concluded that varicocelectomy improve PE in patients with bilateral clinical varicoceles and PE. Further prospective, controlled studies are needed to provide further characterization of this potential relationship.

Background and Objectives: Chronic kidney disease (CKD) is a common health problem in Bangladesh. Etiological factors of CKD are very vital for management but largely unknown in our setting. Hence, the main objective of the study is to identify etiology of CKD of patients who are on maintenance hemodialysis (MHD) at different dialysis units of Chittagong. Methods: This descriptive study was conducted on 107 patients of CKD who were on MHD in different dialysis centers of Chittagong town, Bangladesh. A pretested questionnaire was adopted from previous study addressing different etiology of the CKD. This study was based solely on history and previous health records. After collection of data, it was compiled and analyzed manually. Results: In the present study, there were 61.62% males and 38.31% females and male-female ratio was 1.61:1. Majority (42 [39.25%]) of the patients were in the age group of 50-60 years, next to which was 40-50 years (23 [21.49%]). Diabetes mellitus (DM) with or without hypertension (HTN) was found as the most common etiology (70 [65.45%]) of CKD in our study, next to which was HTN (53 [49.53%]), nonsteroidal anti-inflammatory drug (NSAID) (15 [14.1%]), chronic glomerulonephritis (7 [6.54%]), polycystic kidney disease (6 [5.60]), systemic lupus erythematosus (1 [0.93%]), contrast-induced (1 [0.93%]), and following acute kidney injury (1 [0.93%]). Only 4 (3.73%) cases were found to have biopsy-confirmed nephritis. Conclusion: DM was found the most common etiology of CKD among patients who are on MHD in Bangladesh, next to which was HTN. Maximum patients had no biopsy proof of CKD and NSAID constituting a significant segment of etiology which is a potentially preventable etiology, in our setting.

Background and Objectives: Pruritus is an unpleasant cutaneous sensation prompting a desire to scratch. It can be very disturbing and is common in patients on maintenance hemodialysis (HD). Its pathogenesis is not very clear but has been attributed to diverse factors including uremia and iron deficiency anemia. The aims and objectives of this study are to determine the frequency of pruritus in HD patients in Benin City, to evaluate the relationship of pruritus in these patients with age, sex, body mass index (BMI), skin changes, peripheral neuropathy, duration of dialysis, and laboratory findings including packed cell volume (PCV), creatinine, urea, calcium, and phosphate, and to get the percentage of patients with increasing pruritus during and after dialysis. Methods: Consenting patients on maintenance HD were consecutively recruited into the study. Some relevant clinical and laboratory parameters (age, sex, BMI, skin changes, neuropathy, presence of pruritus, severity and intensity of pruritus, serum urea, creatinine, calcium, and phosphate) were evaluated using the SPSS version 17 package. Results: A total of fifty patients participated in the study. Twenty-four (48%) of these patients had pruritus. Of the 24 patients with pruritus, 14 (58.3%) were males while 10 (41.7%) were females. The mean age, BMI, and duration of HD of the patients with pruritus were 51.0 ± 13.61 years, 23.3 ± 1.77 kg/m ² , and 7.4 ± 9.31 months, respectively. In addition, the mean serum urea, calcium, and PCV of the patients were 252.1 ± 65.10 mg/dL, 7.0 ± 1.04 mg/dL, and 25.5% ±4.38%, respectively. Eight (33.3%) had an increasing intensity of pruritus during and after HD. Twelve (50%) of the patients had mild pruritus while another 12 (50%) had moderate pruritus. There was no case of severe pruritus. Anemia, serum urea, duration of HD and increasing the age of patients were found to be significantly related to pruritus. Conclusion: Pruritus is relatively prevalent among our patients on maintenance HD and factors significantly associated with this condition include anemia, serum urea, and increasing the age of the patient as well as duration on HD.

The incidence of end-stage renal disease (ESRD) increases in the elderly population. Patients received kidney transplantation have better long-term survival and quality of life than those received maintaining dialysis. However, only a smaller proportion of the elderly patients receive kidney transplantation because of the concerns about high posttransplant complications such as infections and diabetes. In this review, we make a discussion on treatment strategies including prophylaxis of risk factors, donor selection, and postoperative monitoring to raise awareness and improve long-term prognosis in the elderly patients with ESRD.

Although renal disease has been present for over 200 millennia of Homo sapiens' existence, knowledge of the causes and management of these disorders has only emerged during the last 4000 years. Brilliant insights into human disease probably emerged from time to time over the long period of human existence, but observations could only be advanced after writing began in 3200 BC. Humans could then make observations, record these thoughts, and have others in their present and future critique them leading to improvement in this information. This discussion selectively considers some of the medical giants who led the way to clinical nephrology of the 21^st century. It reflects on who taught us basic principles of renal disease that led to our current knowledge. Attention is given to the ancient Egyptians, Ancient Greeks, Galen of Pergamon, the Byzantine Greeks of the 5^th-9^th centuries, the Arab/Persian Physicians of the 9^th-12^th centuries, Moses Maimonides of the 12^th century, selective Renaissance Physicians, and the father of modern nephrology - Richard Bright MD. This reflection celebrates au courant renal sagacity by celebrating the past clinicians who led the way from their eras to ours.

Radical cystectomy with ileal conduit is one of the treatment options for patients with muscle invasive carcinoma bladder. Giant ileal conduit calculus is a very rare complication. A 60-year-old male had undergone radical cystectomy with ileal conduit about 12 years back and now presented left gross hydrourereteronephrosis with perinephric collection and features of renal failure. We performed drainage of perinephric collection followed by left sided percutaneous nephrostomy and patient's condition improved gradually. Later on, we performed contrast-enhanced computed tomography (CT) intravenous urogram and nephrostogram which revealed a huge calculus of size 9 cm × 5 cm in the ileal conduit. Calculus was removed by open surgery by incising the conduit over antimesenteric border. Above presentation is a sequel of a huge ileal conduit calculus obstructing left ureter. Calculus formation can result from stomal stenosis, metabolic acidosis, small bowel syndrome, recurrent infection, any foreign body like a staple or nonabsorbing suture material. These patients require close surveillance with X-ray kidney, ureter, and bladder for a longer period after the urinary diversion. In doubtful cases, helical CT may be useful. Giant ileal conduit calculus is a very uncommon presentation after radical cystectomy.

Bilateral subconjunctival hemorrhage is usually caused by conjunctivitis and trauma. Other causes are straining, sneezing, coughing, or vomiting. We report here two cases of severe stricture urethra who presented to us with bilateral subconjunctival hemorrhage. Both patients had to strain for more than half an hour to empty bladder once, since many months. On evaluation both patients were found to have very narrow segment stricture urethra, underwent subsequent augmented urethroplasty and in about 3 weeks subconjunctival hemorrhage resolved on its own. We conclude that bilateral subconjunctival hemorrhage could be potential presenting sign of stricture urethra in patients who strain severely to empty their bladder.

Objectives: To assess the accuracy of Prader's orchidometer and ultrasonography in estimating the volume of testis against the actual volume of testis as measured by Archimedes principle of water displacement. Subjects and Methods: Fifty-six patients with advanced prostate cancer had an estimation of testicular volume by Prader's orchidometer by the same urologist and ultrasonography by the same radiologist. Lambert's formula was used for calculating the volume of testis. All patients underwent bilateral orchiectomy, and the actual volume of the testes was estimated by the water displacement method. Results: Mean age of patients was 71.53 years. The reliability of both the methods was calculated by Bland-Altman plot. The discrepancy of individual measurement and the bias (average discrepancy) was calculated for each method separately, and the plot was derived. In both the plots, the values were more concentrated around the value 0, showing that both were reliable in measuring the volume accurately. Conclusions: The volume of testis measured by Prader's orchidometer correlated with that measured by ultrasonography as well as the actual volume measured by water displacement method. This method is hence useful in office practice, community screening, adolescent clinics, and teen clinics.

Background and Objectives: Tubulointerstitial fibrosis (TIF), the common pathway of chronic kidney disease (CKD) to end-stage kidney disease, is sorely lacking of effective drugs in prevention, even synthetic chemical drugs have made significant progress. Therefore, this study was to investigate the effects of Danhong (active agents of Salvia miltiorrhiza and safflower Carthamus) on TIF in early CKD with unilateral nephrectomy animal model. Materials and Methods: Forty Sprague-Dawley rats were randomly divided into four groups (each n = 10): A, control; B, CKD; C, CKD + Danhong; and D, CKD + Losartan. In Group A and B, rats were treated with normal saline for 12 weeks. In Group C and D, rats were treated with Danhong (8 mL/kg/day) and losartan (20 mg/kg/day), respectively. The concentrations of angiotensin II (Ang II) and transforming growth factor (TGF-β) in kidney were measured by immunohistochemistry technique and enzyme-linked immunosorbent assay. The relationship among the indicators relating to TIF was analyzed. Data were collected and analyzed using SPSS software. Results: The concentrations of Ang II and TGF-β in renal cortex homogenate, TGF-β1 positive area in renal cortex tissue, and semi-quantitative nephropathological scores of TIF were dramatically lower in CKD rats treated with Danhong, compare with those without Danhong management. Conclusions: Danhong has a protective effect on TIF in CKD rats, similar to losartan, may through a series of approach including suppression of Ang II and TGF-β in kidney.

Background and Objectives: Studies have investigated the effect of antihypertensive treatment in patients with hypertensive nephrosclerosis. To our knowledge, there is no cohort study on the effect of antihypertensive treatment in elderly patients with nephrosclerosis. Therefore, our aim was to evaluate the efficacy and risks associated with the use of antihypertensive agents, especially renin-angiotensin system (RAS) inhibitors, in this population. Patients and Methods: This was a retrospective cohort study. Patients aged ≥65 years and diagnosed with nephrosclerosis who were treated in our department between August 2013 and October 2014 were included in this study and were observed for 12 consecutive months. Results: Forty-three patients were included in this study. Thirty-three patients were men, and 10 were women. The mean age of the subjects was 79.3 ± 7.1 years. At the start of this study, mean values of serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) were 2.48 ± 1.32 mg/dL and 25.0 ± 12.8 mL/min/1.73 m ² , respectively. At the end of the observation period, hemodialysis was initiated for 5 patients. The mean value of eGFR decreased by 12.2 ± 21.5%, and 3 patients had a decrease of more than 30% in eGFR. Cr values at the start correlated positively with the percentage of decrease in eGFR. Cr values at the start and RAS inhibitor usage rate were significantly associated with adverse effects, such as hyperkalemia and transient Cr elevation. Conclusion: Our study suggests that antihypertensive treatment with RAS inhibitors may cause adverse effects in elderly patients with nephrosclerosis. Caution should be exercised when administering RAS inhibitors to these patients.

Human immunodeficiency virus (HIV)/AIDS is unique for its devastating impact on social, economic, and demographic developments. Recent studies have thrown more light on the reasons for the mortality and morbidity associated with HIV/AIDS in general and on its renal complications in particular. The classic involvement of the kidney by HIV infection in HIV-associated nephropathy (HIVAN) was reported in New York in 1984. HIVAN clinically presents with proteinuria and renal dysfunction and pathologically with focal segmental glomerulosclerosis. The imaging modality most commonly used in the assessment of renal dysfunction is ultrasonography, followed by computerized tomography. These renal lesions manifest in a protean number of ways in sonography. Renal survival has improved with the introduction of highly active antiretroviral therapy.

The elderly are at high risk of chronic kidney disease, who has become a major population in the newly admission to dialysis treatment. So the elderly will be the focus of CKD prevention task in future. At present, challenges still remain in the diagnosis and treatment of CKD in the elderly: there is no unified criteria for CKD diagnosis in the elderly, un-settled treatment target of CKD complications in the elderly; complicated theraputic strategies in the elderly ESRD patients. We particularly stress the importance of patient-centered, instead of disease-oriented, individualized treatment in the prevention and treatment of CKD in the elderly.

Priapism is common urologic emergency that may lead to permanent erectile dysfunction. It is frequently idiopathic in etiology, but there is a known complication of pharmacologic agents such as intracavernosal agents, antihypertensives, and anticoagulants. Polysaccharide sulfate (PPS) is a new type of heparinoid drugs that extracted from phylum phaeophyta with function of anticoagulant, antilipemics, and improvement of microcirculation. PPS-induced priapism is a kind of serious side effects and is rising. General practitioners and traditional Chinese doctors should learn about the serious complication and all patients with PPS should be warned about of erectile dysfunction. Patients presenting with priapism deserve special counseling, beginning with the first episode of priapism. Patients must understand that a poor outcome is possible despite appropriate and timely management.

We report a 76-year-old man who was diagnosed with bilateral hilar lymphadenopathy and elevated level of angiotensin-converting enzyme 3 years ago, and uveitis 2 years ago. He was performed lithotripsy for bilateral urinary tract calculi 1 year ago and referred to our department for chronic kidney disease. After then, urinary tract calculi relapsed and lithotripsy was performed 5 times and the level of adjusted calcium maintained from 10 to 12 mg/dL. In 2014, the level of creatinine (Cr) increased gradually, and abdominal computed tomography showed as many as 19 urinary tract calculi. We diagnosed this case as sarcoidosis clinically. The frequent recurrence of urinary tract calculi seemed to be caused by hypercalcemia derived from sarcoidosis, so we treated hypercalcemia by prednisolone 30 mg/day. Then the level of calcium and Cr improved rapidly. We should take the probability of sarcoidosis into consideration for the frequent recurrence of urinary tract calculi and hypercalcemia.

We report a case of an isoniazid-induced cerebellitis and psychosis in chronic kidney disease patient with tubercular pleural effusion recovered after reducing the dose of isoniazid. This case is being reported from the National Institute of Medical Sciences, Jaipur, Rajasthan, India.

Peyronie's disease (PD) is an acquired fibrotic disease of the penile tunica albuginea accompanied by penile pain, curvature, erectile dysfunction, and psychosocial problems. Recent evidence suggests an increasing prevalence of PD with current uncertainty of its etiology and pathophysiology. According to the natural history of PD, the disease can be divided into acute phase and fibrotic phase that greatly determines the treatment plan. Oral, intralesional medication, and topical therapy are suitable for acute phase while surgical therapy is suggested only in fibrotic phase with the formation of stable plaques. Although a number of pharmacologic agents have been evaluated in preclinical and clinical studies, a few of them can be used in the clinic with satisfactory outcome. Recent studies showed promising results in improving symptoms and limiting disease progression, especially the only Food and Drug Administration-approved collagenase Clostridium histolyticum as well as some multimodal therapies. In this study, we reviewed currently available medications and focused on recent advances in PD pharmacotherapy. However, further high-quality studies are much needed to clarify the pathogenesis of PD and, more importantly, to find out effective and safe medicines for PD treatment.

Pregnancy with chronic kidney disease carries substantial risk to the mother and the baby. Incidence of women becoming pregnant while having chronic kidney disease is increasing. The major risk to the mother is development of preeclampsia which may be hard to diagnose in patients with chronic kidney disease. Depending on the kidney function, women may also be at risk of decline in their kidney function. The major risk to baby is prematurity. The renal physiological changes that occur with pregnancy are quite profound and normal values of blood pressure, electrolytes and parameters to monitor kidney function are different then in non-pregnant state. Counselling these women about pregnancy and managing them through pregnancy remains a challenge. This review discusses the physiological changes that occur during pregnancy, risks of pregnancy with CKD and management of CKD during pregnancy.

Proteinuria is the hallmark of nephrotic syndrome and a surrogate of progression of renal disease and a risk factor of cardiovascular morbidity. Once proteinuria occurs secondary to glomerular damage, its reabsorption at the proximal tubule causes a constant interstitial inflammation that will eventually lead to a graduate loss of kidney function due to fibrosis, ischemia and tubular atrophy. The plasminogen-plasmin system plays a local critical role in amplifying podocyte damage, deepening the generation of edema, cross-linking inflammatory components at the interstitium and determining the terminal fibrotic processes. Plasmin activity also causes inflammation through the complement system. The interaction between the complement and the plasminogen-plasmin systems is critical in the progression of interstitial inflammation. Plasmin is capable of cleaving C3 and C5 components of the complement system. Moreover, C3a and C5a fractions are chemoattractants of neutrophils and monocytes. The complement system is also involved in microvascular thrombosis contributing to glomerular sclerosis and interstitial fibrosis through ischemic processes. A regulator of plasmin activity is plasminogen activator inhibitor-1, a leading molecule involved in fibrosis and sclerosis, particularly augmented in glomerulopathies. Unraveling the interactions between the plasminogen-plasmin and complement systems will undoubtedly lead to more specific therapies for glomerular diseases.

Objective: The article outlines informational content of the methods used for treatment and diagnostic algorithm development for patients with different types of penile deformations. Materials and Methods: For last 10 years there 189 patients with penile deviations were examined and treated. For diagnostic we used questionnaires, US with Doppler, MRI and CT. According to erectile function, presence of inflammation in plaque methods of treatment (surgical or conservative) was chose. Results: Positive results were observed in 94% of patients after Nesbit operations (corporoplication) and in 82% of patients after corporoplastic. Effectiveness conservative treatment was about 70%. Conclusions: Pre-surgery examination of patients with penile curvature and any type of deformation must comprise ultrasound and pharmacodopplerography along with the medical history and physical examination. In controversial clinical cases in order to prove or discard possible inflammatory peri-process it is necessary to conduct MRI.

Background and Objective: Diabetic nephropathy is the most common cause of microvascular chronic complication of Type 2 diabetes mellitus (T2DM), which is associated with considerable morbidity and mortality. Chronic kidney diseases (CKD) may result from diabetes mellitus (34%), hypertension (29%), glomerulonephritis (14%), and others (23%). The present study was undertaken to explore the possibility of the serum cystatin C level as a marker of early renal impairment in T2DM patient. Materials and Methods: The study was conducted in 75 patients of T2DM and 75 healthy individuals were included as control in this study. After 12 h fasting, 8 mL venous blood sample was collected and allowed to clot for ΍ h and serum was separated. Lipid profile and cystatin C level of serum were measured by using commercially available kit of auto analyzer. Results: The level of serum cystatin C was significantly increased in T2DM patients as compared to control. In T2DM patients, high-density lipoprotein cholesterol significantly decreased (P < 0.001), while other parameters of lipid profile were significantly increased (P < 0.001) as compared to control group. Conclusion: Present study suggests that cystatin C measurement in serum is a useful, practical, noninvasive tool for the evaluation of renal involvement in the course of diabetes, especially patients, and the study also shows significant lipoprotein abnormalities in T2DM patients when compared to control.

Background and Objective: The ankle-brachial index (ABI) is a noninvasive method used to predict subclinical atherosclerosis in patients with chronic kidney disease (CKD). Studies regarding this are lacking in India, especially in a rural setting. Here, we have tried to determine the prevalence of peripheral arterial disease (PAD) by manual ABI, which is a low-cost diagnostic tool than Doppler ABI. Materials and Methods: This is a prospective observational study carried out over a period of 2 years enrolling 240 patients with CKD within the age group of 17-85 years. All patients and controls underwent thorough clinical examination and required laboratory investigation. Statistical analysis was carried out using statistics using the Z-test for the difference in comparison and calculation of P values. Results: The mean age of presentation was 47.91 ± 14.23 with a male preponderance of 161 (67.08%). The relation between hemodialysis (HD) and peripheral vascular disease and its duration were compared which showed significantly lower ABI values in patients who were on HD −0.87 ± 0.05 (manual), 0.90 ± 0.09 (Doppler); off HD: 0.89 ± 0.07 (manual), 0.93 ± 0.07 (Doppler) with P = 0.008 (manual), 0.007 (Doppler), and longer duration of HD (>6 months), showing lower ABI values which were statistically significant ≤6 months: 0.88 ± 0.05 (manual), 0.90 ± 0.10 (Doppler); >6 months: 0.85 ± 0.05 (manual), 0.88 ± 0.06 (Doppler). Conclusion: The correlation of both methods of ABI was compared with different stages of CKD in detecting PAD that showed that both methods were equally effective in detecting CKD in different stages.

There have been many advances in the surgical treatment for benign prostate hyperplasia (BPH), moving from open surgery (retropubic and suprapubic open prostatectomy) to transurethral resection of the prostate (TURP, the historical gold standard and still the most commonly used approach), and onto endoscopic transurethral enucleation. The application of new laser and plasma technologies now allows the precise transurethral enucleation of the prostate (PTUEP). In our medical center, we have found great success using PTUEP. Many urologists have found that PTUEP reduces perioperative complications and risks during operation. It can be applied to all size prostates and can even be used with BPH patients taking anticoagulation medicine. PTUEP is quickly replacing TURP as an effective and less invasive approach to BPH surgery.

Antineutrophil cytoplasmic antibodies (ANCAs) associated vasculitis is a necrotizing vascular inflammation, usually involving multiple organs. It is one of the major diseases that cause deterioration of renal function rapidly in the elderly. The latest Chapel Hill Consensus Conference 2012 has updated the name of ANCA-associated vasculitis. Some high quality randomized clinical trials provide the evident basis for the treatment of vasculitis. However, elderly patients often suffer complex diseases, and are associated with underlying diseases, so it is difficult to be diagnosed and treated. It is very important to make optimized individual strategies of treatment for elderly patients with vasculitis.

This paper introduces academic thoughts and clinical experience of Xu Songnian, a famous modern clinical Traditional Chinese Medicine (TCM) doctor in Shanghai. He studied medical knowledge under Ding Jiwan's guidance. Dr. Ding Jiwan was the descendant of the Zhang Family Internal Medicine. After accumulating clinical experience for a decade, Xu Songnian had concluded unique insights in the treatment of miscellaneous diseases. Dr. Xu put his concentration on the development of renal disease treatment in middle age and gradually formed a set of theoretical system in clinical experience, which made great contribution to the later TCM renal disease development. This paper will give restricted understanding of Dr. Xu's academic thoughts and make a brief introduction of it.